Surgical Tactics of Curing Patients with Complications of Locally Advanced Stomach Cancer

The problem of treating complicated forms of stomach cancer remains relevant. Up to 80% of patients enter treatment in the III and IV stages of the disease. The problem of providing urgent oncosurgical care to patients with complications of stomach cancer remains far from being resolved. The incidence of postoperative complications varies from 16.3 to 48.0% and mortality from 12.0 to 37.2%. The results of surgical treatment depend on the choice of surgical tactics and the scope of the primary operation. The aim of the study was to improve the results of treatment of patients with complications of locally advanced gastric cancer. A two-stage surgical tactics with wide application of minimally invasive interventions at the first stage of treatment was developed. The analysis of the results of operative treatment of 418 patients with complicated locally expanded gastric cancer. All patients were randomized into two groups: comparison group – 212 patients (were cured from 2006 to 2010), the main – 206 patients (treatment period was from 2011 to 2015). The disease was complicated by bleeding in 252 (60.3%) patients, stenosis – in 89 (21.3%), perforation – in 15 (3.5%), their combination – in 62 (14.8%). Endoscopic hemostasis was performed in 49 (11.7%) patients with continued bleeding from the stomach tumor, which allowed delayed surgery for 2-6 days after admission. X-ray endovascular hemostasis was performed in 31 (7.4%) patients. The application of the first stage of minimally invasive hemostasis methods allowed to reduce the number of urgent operations from 46 (11.0%) in the comparison group to 13 (3.1%) in the main group. Deferred procedures were performed in 80 (19.1%) patients, of which 59 (14.1%) of the patients were in the main group. Two-stage operative interventions were performed in 9 (2.1%) patients with perforation of the stomach tumor. Radical surgery was performed in 168 (40.2%), in 250 (59.8%) – palliative and symptomatic. In 106 (25,3,2%) patients of the main group of patients, combined gastric resection with lymphodissection D2. Combined gastrectomy with resection of the transverse colon was performed - in 36 (8.6%) patients, with liver resection - in 35 (8.3%) patients, resection of the pancreas in combination with splenectomy and without it - in 32 (7.6 %) of patients, splenectomy - in 14 (3.3%), in 51 (12.2%) patients performed multiversal resections. Postoperative complications arose to 82 patients (19.6%) and postoperative mortality to 7.2% (30 patients). Conclusions. We consider it expedient to use two-stage surgical tactics with the use of minimally invasive surgical interventions to patients with complicated locally advanced stomach cancer. The introduction of proposed surgical tactics and new operations contributed to the increase in number of radical operations from 62 (14.8%) to 106 (25.3%) in the main group and a decrease in postoperative mortality from 8.0% to 6.3% . The results can be used in the surgical treatment of complicated gastric cancer. Thus, in the treatment of gastric cancer with invasion of neighboring organs, in the presence of life-threatening complications, the two-stage surgical tactics is the most effective.